Journal of General Internal Medicine

, Volume 34, Issue 8, pp 1641–1644 | Cite as

Just a Game: the Dangers of Quantifying Medical Student Professionalism

  • Roshini Pinto-PowellEmail author
  • Timothy Lahey


A medical student on her internal medicine clerkship says her numerical medical professionalism grade was “just a game.” Building on this anecdote, we suggest there is good reason to believe that numerical summative assessments of medical student professionalism can, paradoxically, undermine medical student professionalism by sapping internal motivation and converting conversations about core professional values into just another hurdle to residency. We suggest better ways of supporting medical student professional development, including a portfolio comprised of written personal reflection and periodic 360° formative assessment in the context of longitudinal faculty coaching.


professionalism education medical disincentives 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


  1. 1.
    Medicine AFABoI, Medicine A-AFACoP-ASoI. European Federation of Internal M. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–6.CrossRefGoogle Scholar
  2. 2.
    Hook L, Salami AC, Diaz T, Friend KE, Fathalizadeh A, Joshi ART. The Revised 2017 MSPE: Better, But Not “Outstanding”. J Surg Educ. 2018;75(6):e107-e11. CrossRefPubMedGoogle Scholar
  3. 3.
    Frohna A, Stern D. The nature of qualitative comments in evaluating professionalism. Med Educ. 2005;39(8):763–8. CrossRefPubMedGoogle Scholar
  4. 4.
    Shrank WH, Reed VA, Jernstedt GC. Fostering professionalism in medical education: a call for improved assessment and meaningful incentives. J Gen Intern Med. 2004;19(8):887–92. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Birden HH, Usherwood T. “They liked it if you said you cried”: how medical students perceive the teaching of professionalism. Med J Aust. 2013;199(6):406–9.CrossRefGoogle Scholar
  6. 6.
    Doucleff M. A Lost Secret: How To Get Kids To Pay Attention. National Public Radio; 2018.Google Scholar
  7. 7.
    Deci EL, Koestner R, Ryan RM. A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychol Bull. 1999;125(6):627–68. discussion 92-700.CrossRefGoogle Scholar
  8. 8.
    Roche M, Haar JM. A metamodel approach towards self-determination theory: a study of New Zealand managers’ organisational citizenship behaviours. Int J Hum Resour Manag. 2013;24(18):3397–417. CrossRefGoogle Scholar
  9. 9.
    Ten Cate TJ, Kusurkar RA, Williams GC. How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE guide No. 59. Med Teach. 2011;33(12):961–73. CrossRefPubMedGoogle Scholar
  10. 10.
    Egnew TR, Lewis PR, Meyers KR, Phillips WR. The Suffering Medical Students Attribute to Their Undergraduate Medical Education. Fam Med. 2018;50(4):296–9. CrossRefPubMedGoogle Scholar
  11. 11.
    Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. J Gen Intern Med. 2007;22(10):1434–8. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Chen DC, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH. Characterizing changes in student empathy throughout medical school. Med Teach. 2012;34(4):305–11. CrossRefPubMedGoogle Scholar
  13. 13.
    Griffith CH 3rd, Wilson JF. The loss of student idealism in the 3rd-year clinical clerkships. Eval Health Prof. 2001;24(1):61–71. CrossRefPubMedGoogle Scholar
  14. 14.
    Hojat M, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182–91. CrossRefPubMedGoogle Scholar
  15. 15.
    Mader EM, Roseamelia C, Morley CP. The temporal decline of idealism in two cohorts of medical students at one institution. BMC Med Educ. 2014;14:58. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Li H, Ding N, Zhang Y, Liu Y, Wen D. Assessing medical professionalism: A systematic review of instruments and their measurement properties. PLoS One. 2017;12(5):e0177321. doi: CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Irby DM, Hamstra SJ. Parting the Clouds: Three Professionalism Frameworks in Medical Education. Acad Med. 2016;91(12):1606–11. CrossRefPubMedGoogle Scholar
  18. 18.
    Gordon J. Fostering students’ personal and professional development in medicine: a new framework for PPD. Med Educ. 2003;37(4):341–9.CrossRefGoogle Scholar
  19. 19.
    Bryden P, Ginsburg S, Kurabi B, Ahmed N. Professing professionalism: are we our own worst enemy? Faculty members’ experiences of teaching and evaluating professionalism in medical education at one school. Acad Med. 2010;85(6):1025–34. CrossRefPubMedGoogle Scholar
  20. 20.
    Gracey CF, Haidet P, Branch WT, Weissmann P, Kern DE, Mitchell G, et al. Precepting humanism: strategies for fostering the human dimensions of care in ambulatory settings. Acad Med. 2005;80(1):21–8.CrossRefGoogle Scholar
  21. 21.
    Riveros R, Kimatian S, Castro P, Dhumak V, Honar H, Mascha EJ, et al. Multisource feedback in professionalism for anesthesia residents. J Clin Anesth. 2016;34:32–40. CrossRefPubMedGoogle Scholar
  22. 22.
    Goss BD, Ryan AT, Waring J, Judd T, Chiavaroli NG, O’Brien RC, et al. Beyond Selection: The Use of Situational Judgement Tests in the Teaching and Assessment of Professionalism. Acad Med. 2017;92(6):780–4. CrossRefPubMedGoogle Scholar
  23. 23.
    Murray J. Development of a Medical Humanities Program at Dalhousie University Faculty of Medicine, Nova Scotia, Canada, 1992-2003. Acad Med. 2003;78(10):1020–3.CrossRefGoogle Scholar
  24. 24.
    Krackov SK, Levin RI, Catanese V, Rey M, Aull F, Blagev D, et al. Medical humanities at New York University School of Medicine: an array of rich programs in diverse settings. Acad Med. 2003;78(10):977–82.CrossRefGoogle Scholar
  25. 25.
    Andre J, Brody H, Fleck L, Thomason CL, Tomlinson T. Ethics, professionalism, and humanities at Michigan State University College of Human Medicine. Acad Med. 2003;78(10):968–72.CrossRefGoogle Scholar
  26. 26.
    Franco RS, Franco CAGdS, Pestana O, Severo M, Ferreira MA. The use of portfolios to foster professionalism: attributes, outcomes, and recommendations. Assessment & Evaluation in Higher Education. 2017;42(5):737–55. doi: CrossRefGoogle Scholar
  27. 27.
    Kopechek J, Bardales C, Lash AT, Walker C Jr, Pfeil S, Ledford CH. Coaching the Coach: A Program for Development of Faculty Portfolio Coaches. Teach Learn Med. 2017;29(3):326–36. CrossRefPubMedGoogle Scholar
  28. 28.
    Lovell B. What do we know about coaching in medical education? A literature review. Med Educ. 2018;52(4):376–90. CrossRefPubMedGoogle Scholar
  29. 29.
    Gifford KA, Fall LH. Doctor coach: a deliberate practice approach to teaching and learning clinical skills. Acad Med. 2014;89(2):272–6. CrossRefPubMedGoogle Scholar
  30. 30.
    Ziring D, Danoff D, Grosseman S, Langer D, Esposito A, Jan MK, et al. How Do Medical Schools Identify and Remediate Professionalism Lapses in Medical Students? A Study of U.S. and Canadian Medical Schools. Acad Med. 2015;90(7):913–20. CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Department of MedicineGeisel School of Medicine at DartmouthHanoverUSA
  2. 2.Dartmouth-Hitchcock Medical CenterLebanonUSA
  3. 3.Department of Medical Education Geisel School of Medicine at DartmouthHanoverUSA
  4. 4.Larner College of MedicineUniversity of VermontBurlingtonUSA
  5. 5.The University of Vermont Medical CenterBurlingtonUSA

Personalised recommendations